Postoperative rehabilitation does not improve functional outcome in lumbar spinal stenosis: a prospective study with 2-year postoperative follow-up

Aalto, Timo; Leinonen, Ville; Herno, Arto; Alén, Markku; Kröger, Heikki; Turunen, Veli; Savolainen, Sakari; Saari, Tapani; Airaksinen, Olavi

doi:10.1007/s00586-011-1781-y

Cited by 40 publications

(40 citation statements)

References 44 publications

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“…11,56 The minimal changes in back and leg pain for our Education program are similar to findings in trials examining traditional postoperative physical therapy and prospective cohort studies. 1,8,39 Group differences at 3 month follow-up also support work by Abbott et al 3 that found a greater improvement in back pain after lumbar fusion with a 3 session psychomotor therapy program compared to exercise training.…”

Section: Discussionsupporting

confidence: 70%

“…Randomized trials to date have found no significant difference between traditional physical therapy and either no treatment, an educational booklet, or advice to keep active. 1,46,51,52 These results suggest that an alternative approach to postoperative rehabilitation may be needed to address the psychosocial factors often associated with poor surgical spine outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Cognitive-Behavioral–Based Physical Therapy for Patients With Chronic Pain Undergoing Lumbar Spine Surgery: A Randomized Controlled Trial

Archer

Devin

Vanston

et al. 2016

The Journal of Pain

145

156

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The purpose of this study was to determine the efficacy of a cognitive-behavioral based physical therapy (CBPT) program for improving outcomes in patients following lumbar spine surgery. A randomized controlled trial was conducted in 86 adults undergoing a laminectomy with or without arthrodesis for a lumbar degenerative condition. Patients were screened preoperatively for high fear of movement using the Tampa Scale for Kinesiophobia. Randomization to either CBPT or an Education program occurred at 6 weeks after surgery. Assessments were completed pre-treatment, post-treatment and at 3 month follow-up. The primary outcomes were pain and disability measured by the Brief Pain Inventory and Oswestry Disability Index. Secondary outcomes included general health (SF-12) and performance-based tests (5-Chair Stand, Timed Up and Go, 10 Meter Walk). Multivariable linear regression analyses found that CBPT participants had significantly greater decreases in pain and disability and increases in general health and physical performance compared to the Education group at 3 month follow-up. Results suggest a targeted CBPT program may result in significant and clinically meaningful improvement in postoperative outcomes. CBPT has the potential to be an evidence-based program that clinicians can recommend for patients at-risk for poor recovery following spine surgery.

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Section: Discussionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Cognitive-Behavioral–Based Physical Therapy for Patients With Chronic Pain Undergoing Lumbar Spine Surgery: A Randomized Controlled Trial

Archer

Devin

Vanston

et al. 2016

The Journal of Pain

145

156

View full text Add to dashboard Cite

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“…Postsurgical supervised exercise was compared to home exercise or no exercise in two RCTs [13,14]. No differences were found in any of the outcomes, but due to the general benefits of exercise and patient preference, the recommendation favored postsurgical supervised exercise.…”

Section: Resultsmentioning

confidence: 99%

Danish national clinical guidelines for surgical and nonsurgical treatment of patients with lumbar spinal stenosis

et al. 2019

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Purpose To summarize the recommendations from the national clinical guideline published by the Danish Health Authority regarding surgical and nonsurgical interventions in treatment of lumbar spinal stenosis in patients above the age of 65 years. Methods A multidisciplinary working group formulated recommendations based on the GRADE approach. Results Seven of the recommendations were based on randomized controlled trials and three on professional consensus. The guideline recommends surgical decompression for symptomatic lumbar spinal stenosis. Supervised exercise and postsurgical supervised exercise are recommended due to the general beneficial effects of training on general health, even though there was no evidence on an effect on neurogenic pain. The guideline does not recommend manual therapy, paracetamol, NSAIDs, opioids, neurogenic pain medication, muscle relaxants, and decompression combined with instrumented fusion as there was no evidence of the beneficial effect. Conclusion The recommendations are based on low to very low quality of evidence or professional consensus as well as patient preferences and positive or harmful effects of the intervention. The true treatment effect may therefore be different from the estimated effects, which is why the results should be interpreted with caution. The working group recommends intensified research in relation to all aspects of management of lumbar spinal stenosis. Graphical abstractThese slides can be retrieved under Electronic Supplementary Material. Key points 1. A multidisciplinary work group developed a Danish national clinical guideline for non-surgical and surgical treatment in patients over 65 years of age with lumbar spinal stenosis 2. The recommendations were all based on either weak evidence or professional consensus. 3. High-quality RCTs on all aspects of treatment of lumbar spinal stenosis are needed to move the field of research forward. Rousing R, Krüger Jensen R, Fruensgaard S, Strøm J, Brøgger HA, Degn JDM, Andersen MO (2019) Danish National Clinical Guidelines for surgical and non-surgical treatment of patients with lumbar spinal stenosis. Eur Spine J; PICO questionsShould patients with lumbar spinal stenosis be: 1. advised to supervised exercise rather than usual care? 2. offered spinal manual therapy as compared to usual care? 3. be offered paracetamol rather than no treatment with pain medication? 4. offered non-steroidal anti-inflammatory medicine (NSAID) rather than no pain medication? 5. offered opioids in addition to treatment with non-opioid pain medication? 6. offered muscle relaxants in addition to treatment with weak pain medication? 7. offered medication for neurogenic pain in addition to treatment with weak pain medication? 8. offered surgical decompression in case of insufficient effect of non-surgical treatment? 9. offered stabilization procedure (with or without instrumentation) in addition to decompression? 10. offered supervised exercise following surgery for lumbar spinal stenosis rather than no supervision?Rousing R, Krüger Jens...

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“…Group B patients were only advised to stay active. No significant differenced were found between the groups regarding pain, ability to walk and satisfaction with undergone surgical treatment [13]. In this study the patients started physiotherapy as late as three months post surgery.…”

Section: Main Findingsmentioning

confidence: 58%

“…Gru pa A mia ła wdro żo ną fi zjo te ra pię trzy mie sią ce po le cze niu opera cyj nym, na to miast gru pa B mia ła tyl ko za le ce nie by być ak tyw ny mi. Nie stwier dzo no istot nych ró żnic po mię dzy gru pa mi do ty czą cych bó lu, mo żli wo ści cho dze nia i za do wo le nia z ope ra cji [13]. W ba daniach tych cho rzy roz po czę li fi zjo te ra pię do pie ro 3 mie sią ce po ope ra cji.…”

Section: Dys Ku Sjaunclassified

Influence of physiotherapy on patients’ quality of life after decompressive surgery of lumbar spine stenosis

Truszczyńska

2013

Ortop Traumatol Rehabil

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Wpływ fi zjo te ra pii na ja kość ży cia pa cjen tów po ope ra cyj nym od bar cze niu ste no zy lę dźwio we go od cin ka ka na łu krę go we go STRESZCZENIE Wstęp.Fi zjo te ra pia po ope ra cji ste no zy ka na łu krę go we go krę go słu pa lę dźwio we go po win na być in te gral nym pro ce sem le cze nia. Jest to pro ces, któ re go ce lem jest jak naj szyb szy po wrót cho re go do opty mal nej spraw no ści w naj bez piecz niej szy dla nie go spo sób. Ce lem pra cy by ło okre śle nie, czy cho rzy po ope ra cji ste no zy lę dźwio wej sto su ją się do za le ceń fi zjo te ra peu tycznych, oraz wpły wu ćwi czeń po ope ra cyj nych na oce nę ja ko ści ży cia.Ma te riał i me to dy. W ba da niu wzię ło udział 58 cho rych w wie ku śred nim 52,33 ±14,12. Ja kość ży cia ana li zo wa nych cho rych ba da na by ła za po mo cą kwe stio na riu sza WHO QOL -BREF. Ana li za sta ty stycz na. Gdy zmien ne nie za le żne mia ły cha rak ter po dzia łu dy cho to micz ne go sto so wa no test t -Stu den ta dla prób nie za le żnych. W przy pad ku zmien nych nie za leżnych mie rzo nych na po zio mie co naj mniej po rząd ko wym za le żno ści oce nia no za po mo cą nie pa ra me trycz ne go współ -czyn ni ka ko re la cji Tau -Ken dal la. W obu przy pad kach opie ra no się na dwu stron nym po zio mie istot no ści.Wy ni ki. Ćwi cze nia wy ko ny wa ło 31 cho rych (53,4%), 15 cho rych (25,9%) sto so wa ło do za le ceń dba nia o krę go słu p. Wy ni ki ana li zy ja ko ści ży cia uspraw nia nych cho rych by ły znacz nie ob ni żo ne w sto sun ku do norm po pu la cji pol skiej. Regu lar ność wy ko ny wa nych ćwi czeń ko re lo wa ła ze zdro wiem fi zycz nym (tau -b , 224 dla p<0.05), psy chicz nym (tau -b -, 235 dla p<0.05) i śro do wi sko wym (tau -b -, 323 dla p<0.01).Wnio ski. 1. U pa cjen tów z prze by tą, le czo ną ope ra cyj nie ste no zą lę dźwio we go od cin ka ka na łu krę go we go ob ser wu je się znacz ne ob ni że nie ja ko ści ży cia. 2. Znacz na część cho rych pod da nych ope ra cyj ne mu le cze niu ste no zy lę dźwio we go od cin ka ka na łu krę go we go nie jest pod da wa na wcze snej re ha bi li ta cji. Wcze sna, po ope ra cyj na re ha bi li ta cja ma istot ny staty stycz nie wpływ na pod no sze nie ja ko ści ży cia w tej gru pie cho rych. 3. Cho rzy po le cze niu ope ra cyj nym ste no zy dol ne go od cin ka ka na łu krę go we go je dy nie w nie wiel kim stop niu sto su ją zna ne im za sa dy er go no mii od no szą ce się do krę go słu pa i pro wa dzą przed łu żo ną fi zjo te ra pię pro fi lak tycz ną.Sło wa klu czo we: fi zjo te ra pia, ste no za ka na łu krę go we go, ja kość ży cia, le cze nie ope ra cyj ne SUM MA RY Background. Phy sio the ra py after lum bar spi ne ste no sis sur ge ry sho uld be an in te gral pro cess of tre at ment. It is a process who se go al is pa tient 's re turn to opti mal fit ness in the sa fest way. The aim of this stu dy was to de ter mi ne whe ther patients after sur ge ry ap ply to phy sio the ra py re com men da tions, and es ti ma te the im pact of exer ci se on the qu ali ty of li fe.Ma te rials and m...

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Postoperative rehabilitation does not improve functional outcome in lumbar spinal stenosis: a prospective study with 2-year postoperative follow-up

Abstract: The aim was to study if postoperative

Cited by 40 publications

References 44 publications

Cognitive-Behavioral–Based Physical Therapy for Patients With Chronic Pain Undergoing Lumbar Spine Surgery: A Randomized Controlled Trial

Cognitive-Behavioral–Based Physical Therapy for Patients With Chronic Pain Undergoing Lumbar Spine Surgery: A Randomized Controlled Trial

Danish national clinical guidelines for surgical and nonsurgical treatment of patients with lumbar spinal stenosis

Influence of physiotherapy on patients’ quality of life after decompressive surgery of lumbar spine stenosis

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